The HSE “SKIP THE DIP for urinary tract infections in over 65s” quality improvement initiative aims to increase awareness of current best-practice guidance in assessment of UTI in people aged 65 years and older, for all community settings
- HSE guidance states that dipstick urinalysis is not recommended to assess for evidence of UTI in adults aged 65 years and over, or with urinary catheters.
- Bacteria can live in the urinary tract of older people and those with a urinary catheter without causing an infection. This is called asymptomatic bacteriuria (ASB).
- Approximately half of people aged 65 years or older, and all people with an indwelling urinary catheter in place for >30 days, will have ASB.
- In the absence of clinical signs and symptoms of UTI, ASB is not harmful, but dipstick urinalysis can test positive for nitrites and/or leucocyte esterase.
- Positive dipstick urinalysis may lead to antibiotics being prescribed unnecessarily. Antibiotics provide no benefit for ASB in people 65 years or older or with a urinary catheter, and may lead to harm and antimicrobial resistance.
- A diagnosis of UTI should be based on clinical signs and symptoms.
Resources
- Decision aid for the management of suspected UTI in community settings (PDF, 232 KB, 1 page)
- HSE position statements on the use of dipstick urinalysis to assess for evidence of UTI in adults (PDF, 122 KB, 2 pages)
- Skip the Dip Staff Handbook (PDF 887 KB, 16 pages)
- Skip the Dip Toolbox Talk (PDF, 230 KB, 2 pages)
- Urinary tract infection patient information leaflet for adults aged 65 years and over (PDF, 687 KB, 5 pages)
- Antibiotic treatment guidelines